Chapter 10: Chair's concluding remarks

I would firstly wish to acknowledge the strength of views, care
and professionalism that have been brought to this topic both
during, and previous, to my time as Chair of this review.

SUI and
POP are conditions
which, while not life threatening, cause considerable distress to
many women, with disruption of their normal lives. The hope of a
treatment which can reduce that distress and return their lives to
normal is understandably sought eagerly. Similarly, the
gynaecologists and urologists who see these symptoms and the
distress they cause to their patients seek to test and find new and
better ways of producing good outcomes for their patients. The use
of mesh in this clinical area came about because of that desire,
and many women have had a good outcome from these operations.
However, no surgery is without complication, and a number of women
have had both minor and major complications due to the surgery
itself. Indeed, some have found their lives completely transformed,
for the worse, unable to pursue a normal family, personal and
working life.

Balancing both good outcomes and very bad experiences has been
one of the difficult tasks faced by this review. We have taken an
approach of both seeking and sifting the best available research
information on both safety and effectiveness, as well as the
epidemiological information provided by the routine
NHS linked
information which is so rich in Scotland. While extensive, there
are, nonetheless, many gaps, and we have been cognisant of these in
forming our conclusions and recommendations. In addition, we
decided to listen and to reflect on what both our patient and
clinical members told us when applying their expertise and
experience to that research and epidemiology. This led us to the
specific recommendation we make on the use of mesh tape in
particular circumstances and to ask for work on the clinical
pathways to take this concern into account.

We can now see a way by which transvaginal mesh implant surgery
can be supported on a case by case basis but it will require a
number of actions to ensure lessons are learnt and good and safe
patient care is ensured. These are outlined in our recommendations
but include:

informed consent is obtained using approved processes and
information;

an approved clinical pathway is followed;

information, including adverse events, is recorded in a
universal and robust way;

patient treatment and audit is considered as part of a
clinical network involving all practitioners;

the Expert Group develops a pathway and supporting
information for the retropubic approach in
SUI as the
routine mesh procedure with any variation considered as part of
the multi-disciplinary team discussions; and

the Expert Group develops a pathway for the treatment of
POP where
transvaginal mesh is not used routinely but which supports
patients to have access to clinicians with expertise in this area
wherever they live. Any variation in the future must be
considered through a specific multidisciplinary team discussion
after shared decision making with the patient.

Finally, listening is a key part of good and compassionate
healthcare. The many women who began the process leading to this
review, together with the women who valued this surgery and wanted
that benefit to continue, I hope will feel that they have been
listened to and that patient care will benefit as a result.